November 08 - 09 2014, 12:00 AM - 12:00 AM

ASA Quality Meeting 2014



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Self-Education and Evaluation (SEE) Program

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Electronic Health Records

Issue Summary: 

The American Recovery and Reinvestment Act created the Electronic Health Records (EHR) Incentive Program. A majority of anesthesiologists will be deemed “eligible professionals” and thus theoretically eligible to receive the incentive payments for the “meaningful use” of EHRs. Because anesthesiologists were not initially intended to be deemed “eligible professionals” when the law was being debated, the meaningful use requirements do not reflect the typical practice of anesthesiology, making it difficult for anesthesiologists to achieve meaningful use based on the current requirements. Therefore, and as a direct result of ASA’s advocacy efforts, the Centers for Medicare & Medicaid Services (CMS) created a hardship exemption for anesthesiologists in the EHR Incentive Program, which would exempt anesthesiologists from payment penalties that will begin in 2015. However, anesthesiologists do remain eligible for the incentives.

Under the program there are two categories of professionals, “hospital-based eligible professionals” and “eligible professionals”. Hospital-based eligible professionals, despite the name, are actually not eligible to receive the incentive payments (and are exempt from future penalties) because the thinking was that they would use their hospital’s EHR. To be deemed a hospital based eligible professional, one needs to provide 90 percent or more of their covered services in a hospital inpatient or emergency room setting. This is determined by looking at the place of service codes (POS codes) on all the codes one submits for payment under Medicare (21 for inpatient and 23 for ER). The majority of anesthesiologists do not provide 90% or more of their covered services in the hospital inpatient or ER setting unless one exclusively does cardiac, transplant or critical care work, which is rare. The majority of the codes submitted by anesthesiologists are for work done in the outpatient, ASC or office-based setting and therefore, by definition, most anesthesiologists will be deemed “eligible professionals” and thus technically eligible to receive incentive payments. In order to receive the incentive payments one needs to meaningfully use a “certified EHR.”

The Hardship Exemption

The hardship exemption is determined automatically and annually based on a physician’s specialty designation under the Provider, Enrollment, Chain and Ownership System (PECOS). Anesthesiology’s specialty designation is 05. The hardship exemption opportunity could last up to five years; however, CMS could revisit the exemption before then. ASA has and will continue to advocate that this exemption be maintained.

Anesthesiologists may still attempt to become meaningful users and receive incentives, as the hardship exemption applies to the penalties. Receiving an incentive would override the automatic hardship exemption. For more information, please review, the ASA’s Frequently Asked Questions document on Electronic Health Records. 

ASA Action

ASA submitted formal comments to CMS in response to the EHR Incentive Program Stage 2 Proposed Rule, requesting that anesthesiologists be allowed to apply for a hardship exemption.  As a direct result, CMS created a hardship exemption in the EHR Incentive Program Final Rule.  Additionally, ASA has been continuing to advocate that the criteria to meet meaningful use be applicable to anesthesiologists. Recently, ASA submitted formal comments to the Health IT Policy Committee regarding their recommendations for Stage 3. ASA stressed the importance of maintaining the hardship exemption that allows anesthesiologists to avoid the penalties that could result from not being a “meaningful user” of health information technology. ASA had worked with policy makers in support of the exemption that was subsequently granted as part of the Stage 2 Final Rule.

As part of its formal comments, ASA supported the Health IT Policy Committee's recommendation to exclude specialists from the prevention reminder objective and to exclude eligible professionals who do not administer immunizations from the immunization objective. ASA also recommended excluding anesthesiologists from other requirements, including the clinical summary requirement, syndromic surveillance, e-communication with patients and computerized order entry for transfers of care objectives. ASA expressed support for allowing reporting to a registry as a menu objective. ASA also recommended additional flexibility for physicians who achieve a close percentage of the objectives.

Additionally, ASA worked with Congressman Diane Black on legislation that, if enacted into law, would ease anesthesiologists’ participation in the EHR Incentive Program by exempting anesthesiologists from some of the criteria required to demonstrate meaningful use. These include: exempting anesthesiologists from providing clinical summaries to patients, exempting anesthesiologists from being required to provide patients with an electronic copy of their health information and exempting anesthesiologists and other eligible professionals from implementing drug to drug and drug to allergy interaction checks.

Click here to read the ASA letter to CMS regarding Stage 2.

Click here to read the ASA letter to the Health IT Policy Committee regarding Stage 3.

Click here to read the legislation introduced by Rep. Diane Black (R-TN).

Click here to read the ASA Frequently Asked Questions Document on EHRs and Meaningful Use.

Click here to read the letter ASA sent on February 18.

Click here to view the comprehensive chart.

Click here to read the letter ASA co-signed to the Office of the National Coordinator for Health Information Technology regarding the Health Information Technology Policy Committee's (HITPC) proposal for State 2 of the Meaningful Use of Electronic Health Records. 

Click here to read a letter ASA sent on the EHR proposed rule. on March 10, 2010

ASA has also sent a joint letter with the American College of Radiology and the College of American Pathologists. In the letter, the organizations request a meeting with the Health Information Technology (HIT) Policy Committee to discuss considerations for anesthesiologists, pathologists, and radiologists under the Electronic Health Records Incentive Programs. Click here to read the letter. 

On July 21, 2014, ASA submitted comments regarding the Centers for Medicare & Medicaid Services (CMS) proposed modifications to the Medicare and Medicaid Electronic Health Record Incentive Programs for 2014.

For more information please visit http://www.cms.gov/EHRIncentivePrograms/.